- Education: Doctorate
- Experience: 3 years of Physician Advisor Experience
- One or more of the following certifications:
-CCDS
-CDIP
-CCS
-ABQUARP HCQM Certification -
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Chief Physician Advisor - Boise, ID, United States - St. Luke's Health System - Boise, ID
Description
OverviewSt. Luke s Health System seeks a Chief Physician Advisor to join our organization in our journey of improving health and lives by delivering exceptional performance and outcomes in safety and quality, access and affordability .
Reporting to the Chief Physician Executive, the Chief Physician Advisor (CPA) will serve as the Physician Advisor lead for St. Luke s and will be responsible for the development and optimization of the Physician Advisor program. The CPA is expected to be a subject matter expert in Utilization Management including status determinations and denials support. The CPA will be responsible for the development, training, and oversight of the Physician Advisors and will be accountable for the success, consistency, and quality of the Physician Advisor team. In addition, the CPA will provide education for the Physician Advisor team and the clinical staff at St Luke s. The CPA will collaborate with the Utilization Management team to develop and implement best practices for Utilization Management and Physician Advisor related work.
ResponsibilitiesManagement and supervision of the Physician Advisors including hiring, orientation, training, mentoring, quality control, education, and periodic evaluations.
- Develop & implement a utilization review related education plan for clinical providers.
- Serve as subject matter expert and clinical escalation point for the facility physician advisors and the utilization review team.
- Acts as a liaison between and consultant and resource for attending physicians and case management/utilization management teams to collaborate on plans of care, appropriate level of care, length of stay management and issues and alternatives to acute care as needed.
- Consults attending physicians regarding their decisions to appropriateness of hospitalization, continued stay and resource usage.
Identify Utilization Review related process opportunities and collaborate with other departments to optimize workflows and processes.
- Review and suggest improvements to resource allocation and optimized coordination of care processes.
- Assures the development of appropriate education for medical staff members around clinical documentation in the ambulatory and inpatient environments. Identifies opportunities for improving clinical documentation. Coordinate with Quality and Safety leaders to assure that documentation is accurately supporting risk-adjustment in quality performance.
- Partners with medical staff members and medical directors of third-party payors to discuss the needs of patients and alternative levels of care.
- Acts as a resource for the medical staff regarding federal and state utilization and quality regulations.
- Conducts clinical reviews on cases escalated by the case management, utilization management, and denials teams to meet regulatory requirements and efficient utilization of health care services.
- Review denials and author appeal letters. Performs peer to peers with payors. Acts as a liaison with payors to facilitate approvals and prevent denials or carved out days. Assists with payor contracts and optimization.
- Other duties and responsibilities as assigned.
